Best Practice Case Studies-Ureter Rupture

Video Transcription

This is Barry Belosis, one of the musculoskeletal radiology fellows at Stanford University.  Nineteen-year-old male with suspected intra-abdominal injury, concerned for ureteral rupture.  In patients with suspected kidney or ureteral injury, CT abdomen and pelvis with contrast is the modality of choice.  We usually perform non-contrast, aportal venous phase, and coronal delayed imaging to look for any injury.  On this different patient, we can see in her coronal aportal venous phase a hypodensity  surrounding the inferior portion of the right kidney, which may represent urinoma or hematoma.  Here on her coronal delayed imaging, we can see where the arrow is pointing a hyperdensity or bright density in the expected location of the ureter.  Additionally, we can see a defect of continuation between the proximal and distal ureter concerning  for ureteral injury as demonstrated here by some contrast outside the contour of the ureter.  Again, seen is this urinoma or hematoma outside the kidney and some hyperdensity within it concerning for contrast extravasation.

Video Summary

A 19-year-old male suspected of an intra-abdominal injury may have a ureteral rupture. In such cases, a CT abdomen and pelvis with contrast is preferred. Typically, imaging involves non-contrast, portal venous phase, and coronal delayed views. In a presented patient's case, a hypodense area around the right kidney suggests a urinoma or hematoma. Coronal delayed imaging reveals a hyperdense area at the ureter's expected location, indicating possible ureteral injury. A defect is noted at the ureter, suggesting contrast extravasation, with additional hyperdensity within the surrounding area, confirming potential injury.

Meta Tag

Edition 2nd Edition

Related Case 2nd Edition, Case 02

Topic Abdomen

Keywords

2nd Edition, Case 02

2nd Edition

Abdomen

ureteral rupture

CT abdomen

contrast extravasation

urinoma

intra-abdominal injury